WO2015162555A1 - Exocentric surgical device - Google Patents

Exocentric surgical device Download PDF

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Publication number
WO2015162555A1
WO2015162555A1 PCT/IB2015/052907 IB2015052907W WO2015162555A1 WO 2015162555 A1 WO2015162555 A1 WO 2015162555A1 IB 2015052907 W IB2015052907 W IB 2015052907W WO 2015162555 A1 WO2015162555 A1 WO 2015162555A1
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WO
WIPO (PCT)
Prior art keywords
instrument
axis
arches
instrument holder
surgical
Prior art date
Application number
PCT/IB2015/052907
Other languages
French (fr)
Inventor
François Cabaud
Christophe FAVRET
Original Assignee
Iin Medical
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Iin Medical filed Critical Iin Medical
Publication of WO2015162555A1 publication Critical patent/WO2015162555A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A61B90/13—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints guided by light, e.g. laser pointers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins

Definitions

  • the present invention relates to devices used in robotic surgery.
  • Robotic surgery still only concerns a small range of operations, for example interventions via the peritoneum, or operations of prostate cancer.
  • the need to use more widely the surgical robots faces several problems.
  • the main brake is that the morphology of the robots generally used is not adapted to work in microsurgery.
  • robotic surgery uses an opening in the body of the patient through which the various instruments pass.
  • One of the needs is to make the surgery the least invasive possible to limit the trauma due to the operation and to shorten the healing time.
  • a Leksell device In neurology, it is known to use a Leksell device attached to the head of a patient.
  • the application WO 2009/047494 describes a guide for a neurosurgical instrument comprising an arched support attached to a base positioned on the skull of a patient.
  • Such stereotaxic systems are also known in radiotherapy for precisely positioning a non-invasive radio-surgical instrument towards the area to be treated. These devices are not adapted to the use of several instruments focused on the same area.
  • the subject of the invention is a surgical device comprising at least one hoop rotatable about an axis and adjustable in position about this axis and at least one movable carrier along said at least one hoop and adjustable in position on it.
  • the device may comprise a single arch or a set of at least two arches interconnected, in particular traversed by a pivot axis corresponding to the axis of rotation.
  • the instrument holder can be removable.
  • the instrument holders can directly carry a surgical instrument.
  • instrument In the context of the invention, the term "instrument” must be understood in the broad sense, which may mean an element such as a surgical instrument, a camera, a lighting system or a trocar to introduce such an element.
  • At least one instrument holder carries a trocar by which surgical instruments or a camera are introduced into the body of the patient, in particular all the instrument holders carry a trocar.
  • the invention allows the positioning and the holding in position of the instruments throughout an operation.
  • At least one instrument holder may comprise means for actuating the position of the instrument that it carries, in particular actuating at a height relative to the point of intervention targeted by the surgeon.
  • the actuation height can correspond to a translational movement along an axis of the instrument holder.
  • Each instrument holder may thus comprise means for positioning the instrument axially along a proper axis.
  • the axes of axial displacement of the instrument holders can be cut at a fixed point relative to the or the arches, the axes pivoting around said point as a function of the movements of the arches and instrument holders.
  • exocentric In the context of the present application, such a device is described as "exocentric”.
  • An exocentric device is particularly advantageous so that the surgeon during an operation does not permanently lose the focus of the instruments. If the surgeon wishes to leave the central focusing point to work momentarily in its periphery, the invention can allow it, as explained later, to then easily return to the initial position.
  • the invention favors several smaller incisions that are less traumatic, faster to heal and less prone to infections.
  • the invention facilitates in particular the interventions at the level of the lower or upper limbs, for example an operation of the hand or the arm.
  • a device according to the invention may allow interventions on other parts of the body, for example the thorax.
  • the device may comprise a frame integral with the arch or hoops. This is, respectively these are for example mobile (s) relative to said frame, in particular in translation along an axis.
  • the frame comprises for example two parallel rails carried by a frame and along which move or the arches.
  • the frame can be configured to be able to rest, in particular to be fixed firmly, on an operating table so as to choose the orientation of the axis of rotation of the arches, in particular horizontal or vertical.
  • the frame can be configured to be able to rest and be fixed on an operating table so that the axis of movement of the bow or hoops is oriented horizontally or vertically.
  • the frame may comprise two feet, in particular of elongated shape, connected by the two parallel rails.
  • the elongated shape of the legs advantageously allows greater angular variation in the positioning of the hoops.
  • the feet can be configured to provide several possible positions of the device on the operating table.
  • the device may for example rest on long sides of the feet, or small sides or on an outer face of one of the feet.
  • the feet can be configured to rest on a height-adjustable base, comprising for example columns and adjustment means for adjusting the height of the feet along the columns.
  • the adjustment means may for example comprise servo motors or adjusting wheels.
  • the chassis may further comprise at least one movable fastening means along a second axis, in particular perpendicular to the axis of displacement of the arch or hoops, the fastening means being configured to receive, removably or not, a tablet arranged for carry a support for the part to operate of a patient.
  • the fixing means of the shelf comprises for example two movable slides along elongated chassis rails along the second axis.
  • An instrument holder is configured to be mounted on an arch, giving the corresponding instruments several degrees of freedom.
  • An instrument holder may comprise first positioning means on a hoop.
  • An instrument holder can be fixed in a particular position on the hoop by snapping, clamping around the hoop ... this list being nonlimiting.
  • the first positioning means used may be of a type known to those skilled in the art and comprise, for example, a jaw to be clamped on the hoop or a set screw.
  • At least one hoop pivots about the axis of rotation, according to a first rotational movement.
  • a hoop, or all the hoops, may have a curved shape included in a plane.
  • each instrument carrier can be included in a plane defined by the corresponding arch.
  • each carrier is movable along the hoop which supports it in a second rotational movement.
  • At least one of the arches has for example the shape of an arc of a circle, in particular of a semicircle.
  • a bow forms a complete ring.
  • all the arches have the shape of an arc of a circle, in particular of a semicircle.
  • the hoop may be configured to facilitate movement of the implement holder along the hoop and to prevent the hilt from pivoting around the hoop.
  • the section of an arch, or all of the arches, is for example flattened, having in particular a rectangular or square shape.
  • a hoop is composed of several tubes, for example two circular tubes of identical or different section, forming a geometric structure similar to rails.
  • An instrument holder may comprise second positioning means configured to adjust the position of the instrument relative to the corresponding instrument holder.
  • the second positioning means may comprise a clamping system by jaws or pressure screws for axial adjustment of the trocar.
  • the translational movement of the instrument is for example parallel to the plane of movement of the instrument holder on the arch.
  • the axis of the translational movement of the instrument holder can pass through the center of the rotational movement of the instrument holder on the corresponding arch.
  • the instrument may have a rotational movement relative to the instrument holder which carries it, which adds an additional axis of movement.
  • the instrument can thus have the possibility of rotation on itself.
  • the surgical device according to the invention can thus offer at least three degrees of freedom for the positioning of surgical instruments without moving the central point of work.
  • a slight movement of the instrument holder makes it possible to leave the central focusing point in order to work in its periphery.
  • the instrument holder can for example offer two degrees of freedom additional trocar or the instrument that carries.
  • the instrument holder can thus allow a slight rotation and / or translation of the trocar or the instrument.
  • the instrument holder can thus define two additional axes of rotation.
  • the surgical device can still offer a or two additional degrees of freedom for the relative positioning of the arch or arches and the operative site.
  • the displacement of the various elements of the device in order to adjust their respective relative positions as well as their position relative to the operating field can be performed manually.
  • the device may comprise an actuating system.
  • the latter can control movements of a trocar or instrument housed in an instrument holder.
  • the actuation system controls the movements of a tablet for supporting a limb to be operated.
  • the actuating system may comprise a mechanical or electromechanical actuator allowing displacement with a submillimetric adjustment of the positions of the various elements of the device (arches, instrument holders and / or instruments).
  • the actuating system can be motorized and include for example stepper motors to allow to perform, at least in part, the rotations and translations necessary for the movements of the instruments.
  • the actuation system may comprise geared motors.
  • the hoops can be notched thus forming a rack on which can move an instrument holder equipped with a gear motorized particular.
  • the actuating system can be configured to move and hold in position all the instruments carried by an instrument holder and each instrument holder on the corresponding arch.
  • the actuation system controls the movements of the arches relative to each other as well as those of the set of arches relative to the member to be operated.
  • the actuating system is configured to control the movements relative to the frame of a possible tablet for supporting a member to operate.
  • the actuation system can be controlled remotely by a remote control system, in particular via a wireless link.
  • the device may include a security system, including a brake system, which locks at least one degree of freedom, or all.
  • a security system means any means to prevent involuntary and / or uncontrolled relative movement of the various elements of the device.
  • the security system operates for example by friction of moving components between them.
  • the safety system simply comprises the servocontrol of the motors for which a maintenance current is programmed
  • the device can be graduated to facilitate the positioning of each component.
  • the device may have a scale of graduation for each degree of freedom. For example, a hoop or even each hoop has a graduated scale and / or is notched.
  • Each holder can be graduated and / or notched.
  • the frame may comprise a scale graduated according to each axis of movement of the arch or bars attachment means.
  • This graduation can be visual and / or electronic thanks to an encoder known to those skilled in the art, for example an encoder wheel or an electronic caliper.
  • a hoop can carry several instrument holders simultaneously.
  • the number of arches and the number of instrument holders are not limited, only the size of the instrument holders and surgical instruments attached to the device may be a restriction because, depending on the needs, the practitioner must be able to modify the relative position. instruments in the process of intervention.
  • the device comprises for example between one and six arches, including two, three or four arches.
  • the hoop is for example fixed to at least one hub movable about the axis of rotation, or to two hubs diametrically opposite with respect to the hoop.
  • Each arch of the device may comprise two ends, at least one or even each being for example terminated by the movable hub about the axis of rotation of the hoops.
  • the device comprises a single hoop, in particular forming a complete circle, for example secured to a hub movable about the axis of rotation.
  • At least one arch, or even each arch, may have a shape included in a plane, that is to say that the corresponding instrument holder moves in a plane.
  • the plane of movement of the instrument holder may be parallel to the axis of movement of the instrument inside the instrument holder and / or through the axis of rotation of the arch.
  • the plane of movement of the instrument holder is parallel to the axis of rotation of the corresponding arch from which it is distant from a non-zero distance.
  • the plane of movement of the instrument holder may be tangent to the hub, the distance between the axis of rotation of the hoop and said plane being equal to the radius of the hub.
  • the axis of movement of the instrument on the instrument holder is then for example parallel to this plane and distant from the plane by a distance equal to the radius of the hub, the instrument and the center of the hub being on the same side of the plane of movement of the instrument holder
  • the plane of movement of the instrument holder contains the axis of rotation of the arches.
  • the axis of movement of the instrument on the instrument holder is then inclined for example with respect to this plane and, preferably, pivots around a fixed central point of the device when the instrument holder is moved along the arch supporting it.
  • the arches may be integral, being in particular interconnected at their hub.
  • the hubs of the same end of the hoops are for example traversed by a pin-shaped axis, for example a central pivot.
  • the hubs may have shapes that correspond or not.
  • At least one arch may be completely free around the axis of rotation, at least when it carries no instrument holder, that is to say it can rotate 360 ° on itself, independently of the orientation of the other arches.
  • the size of one or more instruments may interfere with such rotation in a particular configuration.
  • the instrument holder can carry, directly or not, a camera and / or a system of separation of the flesh to clear a subcutaneous operating space.
  • a camera When an instrument holder carries a spacer system, the surgeon adjusts the orientation of the axis of the instrument holder and the height of the spacer system so that the subcutaneous space cleared is sufficient.
  • the surgical device comprises a camera attached directly to a hoop and not to an instrument holder. The surgeon adjusts the position of the camera relative to the operating site by fixing the position of the camera on the corresponding arch.
  • the camera and the instruments are carried by an arch. More generally, the surgeon adjusts the position of the instrument relative to the operating site by fixing the position of the instrument holder on the corresponding arch and that of the instrument relative to the instrument holder.
  • Each instrument holder can be removable.
  • the surgical device may comprise a laser pointer to facilitate the adjustment in position of the various components of the device relative to the part to be operated on by the patient.
  • the practitioner or his assistant can fix one or more markers, in particular radiopaque markers, on the limb to be operated.
  • the markers are at least three in number.
  • it uses alternately or complementary morphological landmarks.
  • At least one image is then made by medical imaging, in particular of scanner or / and MRI type in order to determine the point of focus of the surgery and then to choose the vectors of penetration of the instruments.
  • the device can be arranged to calculate, from this selected point, by an algorithm the position of each component of the device (hoop, instrument holder, support) in order to orient the instruments towards the point to be treated.
  • the surgeon adjusts the device in position and positions the limb on the support. By locating with the radio-opaque points of the limb and the laser pointer, the surgeon then makes the various adjustments manually.
  • Cartesian coordinates obtained by the medical images are translated into polar coordinates according to a protocol of the device and the settings are then done automatically.
  • Each holder shaft is positioned to aim at a corresponding area to incise to enter the trocar, instrument or camera into the area to be operated.
  • the subject of the invention is a method for calculating and / or adjusting the position of surgical instruments, in particular during a laparoscopic, diagnostic or surgical procedure, for example lower or upper limbs. .., using a surgical device according to the invention.
  • FIGS. 1 and 2 illustrate in perspective and from the side an exemplary embodiment of a surgical device according to the invention
  • FIGS. 3 to 5 show various orientations and positioning of surgical devices according to the invention
  • FIGS. 6 and 7 illustrate, in isolation and in perspective, variants of the instrument carrier
  • FIG. 8 illustrates a surgical device according to the invention during a wrist operation
  • FIG. 9 is a perspective view of another embodiment of a surgical device according to the invention.
  • Figures 10A to 10E illustrate in section different arches
  • Figure 11 illustrates schematically and in perspective, another embodiment of the surgical device according to the invention.
  • FIG. 1 represents a device 100 according to the invention comprising an assembly 10 of three hoops 1, each terminated at its two ends by a hub 2 movable about the same axis of rotation R.
  • the hoops 1 are integral at the hubs 2 which are in the illustrated example traversed by a central pivot 20.
  • At least one hoop 1 is completely free to rotate about the axis R, that is to say that it can rotate 360 °, in the example shown, the hoop 1 carrying the trocar 150 camera 140 .
  • each arch 1 has the shape of a semicircle and defines a plane P A tangential to the hubs 2 and remote from the axis R by a distance D.
  • Each arch 1 carries an instrument holder 30 configured to move in the plane P A by a circular motion of an angle ⁇ measured from the axis R along the corresponding arch 1.
  • the instrument holders of the illustrated device thus carry a trocar 150 for the passage of a surgical instrument 135 or a camera 140.
  • one of the instrument holders 30 carries a system of separation of the flesh.
  • Each holder defines a Z axis of movement of the trocar 150, the Z axes intersect at a point O.
  • the Z axis is parallel to P A , located at a distance d and on the same side of P A as the hub 2 of the corresponding arch 1.
  • the distances D and d compensate for the point O remains fixed relative to the assembly 10 regardless of the position of the arches 1 and the instrument holders 30 on the arches.
  • the illustrated device is exocentric within the meaning of the invention,
  • the planes P A of the different hoops are intersecting in the axis of rotation R and the axes Z form a non-zero angle with respect to the plane P A.
  • the device 100 further comprises a motorized actuation system 80 comprising geared motors 85, in particular stepwise or direct current, fixed at the hubs 2 in order to control the displacement of the assembly 10 fixed on the sliders 15 according to FIG. X axis and the rotation about the axis R of each arch 1, respectively on each instrument holder 30 to control the movement of the instrument holder along the arch 1 which carries it and the movements of the instrument to inside the instrument holder 30.
  • a motorized actuation system 80 comprising geared motors 85, in particular stepwise or direct current, fixed at the hubs 2 in order to control the displacement of the assembly 10 fixed on the sliders 15 according to FIG. X axis and the rotation about the axis R of each arch 1, respectively on each instrument holder 30 to control the movement of the instrument holder along the arch 1 which carries it and the movements of the instrument to inside the instrument holder 30.
  • the geared motors 85 are remotely controlled via a wired or wireless connection by an actuation system, not shown.
  • the actuation system also includes a brake system not shown to secure the position of the assembly 10, arches 1, instrument holders 30 and trocars.
  • the surgeon can begin by predefining, depending on the operation concerned, the orientation of the arches 1 by rotation of angle around the axis R, each arch 1 pivoting about the axis R according to the double arrow A illustrated in FIG. 2. Then, the practitioner moves the instrument holders 30 along the arches 1 in a circular manner along the double arrow B of FIG. 1.
  • the instrument holders are thus prepositioned so as to limit the overall size when the instruments and the camera are set up so that subsequent movements of the arches or instrument holders are possible during operation without the instrument holders or instruments interfering with each other.
  • angles a and ⁇ can be determined by an algorithm and the corresponding rotations performed by means of the motorized actuation system
  • the presets of the angles a and ⁇ are for example calculated by the algorithm from images of the limb by medical imaging.
  • the practitioner uses, for example, one or more radiopaque markers positioned on the limb to be operated or morphological markers.
  • the surgeon also adjusts the height of the trocars, instruments or camera in each carrier 30 along the Z axis by a rectilinear movement along the double arrow C of FIG.
  • a brake system for example a hydraulic, pneumatic or electromechanical brake
  • the pre-positioned device rests on the operating table by means of two elongated and parallel feet 5 of a frame 50.
  • the surgical device optionally comprises a tablet 60 for receiving the member to operate, for example a hand.
  • the tablet 60 is in particular provided with a support 62.
  • the support 62 may be necessary or not.
  • the surgeon also sets the positioning of the assembly 10 of the arches 1 along the X axis by moving the slides 15 on the slides 16 and the positioning along the Y axis of a tablet 60 removably attached to the frame 50 using the slides 65 movable along the slides 66.
  • the fixing slides 15 and 65 slide on rails 16 and 66 in the form of bars. In an example not shown, the slides move along rails.
  • the device 100 illustrated in FIG. 3 comprises only two arches 1 and one single instrument holder 30.
  • the surgical device illustrated in Figures 1 and 2 is positioned on the operating table so as to rest on the longer sides of the legs 5 of the frame 50, the assembly 10 of the hoops 1 being movable relative to the frame 50 according to the X axis is horizontal, in the configuration of Figure 4, the X axis is vertical.
  • the arches 1 are for example positioned above the area provided for introducing the member to operate.
  • the device illustrated in FIG. 4 does not include a shelf 60 fixed on the slides 15 movable along the Y axis which slide along the slides 66.
  • Figure 5 shows another alternative positioning of a device 100 without a tablet and resting on the longer sides of the legs 5 of the frame 50 placed on an operating table.
  • the arches 1 are set above and below the operative site so as to surround the member to be operated not shown.
  • FIG. 6 illustrates a variant of the instrument holder 30 comprising a hollow attachment portion 33 having a slit of shape and section corresponding to the hoop 1 so as to slide along it and a body 32 traversed by a housing open in which can be inserted and / or slide a trocar 150.
  • the instrument holder 30 is held by friction in the desired position along the hoop 1
  • the trocar is held in the instrument holder by means known to those skilled in the art, in particular by jaw and / or pinch.
  • This variant is particularly suitable for a corresponding camera trocar.
  • FIG. 7 illustrates another example of an instrument holder 30 comprising a fixing portion 34 provided with two pads 33, here in the form of discs, being able to slide along the arch 1 which he sandwiches.
  • the instrument holder comprises a brake system allowing the fixing portion 34 to remain in position by clamping along the hoop 1
  • the instrument holder 30 comprises a body 32 with a housing adapted to receive a trocar for the passage of a surgical instrument.
  • the body 32 of the instrument holder 30 can be adjustable in translation and in rotation relative to an axis W distinct from the Z axis, in particular perpendicular to the Z axis.
  • FIG. 8 illustrates the positioning of a member M to operate on the support 62 of a device according to the invention.
  • the device 100 is similar to that of Figures 1 and 2. It comprises a frame 50 having the shape of a 40 cm square.
  • the invention is not limited to a particular form of chassis. This may be rectangular of dimensions for example between 30 cm and 100 cm.
  • the arches are arcs whose radius is between 25cm and 50cm
  • the surgical device 100 optionally includes a tablet 60 provided with a support 62 for receiving the member to operate, for example a hand.
  • the support 62 and the shelf 60 form here a single piece, being for example made jointly by molding or assembly.
  • one or more points f on the member M After having marked with an opaque radio marker one or more points f on the member M, for example three points as illustrated, one obtains by medical imaging at least one image of the limb and the area to be operated.
  • the imaging system calculates for example the positioning of the member M, arches, and instruments.
  • the surgeon positions the member M on the support 62 according to the indications given by the imaging system. It checks the position with the laser pointer 300 as illustrated. The system checks and possibly corrects the position of each arches 1 and each instrument holder 30 in order to orient the instruments towards the point to be treated located under the skin, at the intersection of the Z axes.
  • the motorized system also regulates the position of the trocars in the instrument holders.
  • Each element of the device 100, hoop, chassis can be made of metal including titanium, stainless steel, aluminum, or a rigid plastic material.
  • the device can be sterilized, in particular several times.
  • the device 100 partially represented in FIG. 9 comprises a single hoop 1 having a complete circular ring shape.
  • the hoop 1 is fixed to a hub 2, mobile in rotation about the axis R.
  • the hoop 1 can rotate 360 ° about itself around the axis of rotation R, even when it carries two instrument holders 30 as illustrated.
  • arches of the surgical devices illustrated above have a section of flattened shape, including rectangular as shown in section in Figure 10A.
  • a hoop may have a section of different shape, square as shown in Figure 10B.
  • a hoop 1 may be composed of several tubes, for example two circular tubes of identical section as shown in Figures 10C and 10D or different as in Figure 10E, forming a geometric structure similar to rails.
  • the tubes are for example adjacent as in Figure 10C or not.
  • both the instrument holders carrying the camera and those carrying the surgical instruments and the corresponding arches can be manipulated via a motorized actuation system.
  • the feet 5 of the device 100 are secured, by means of adjustment means 110, of four columns 120, positioned at the four corners of the device 100, in the extension of the feet 5.
  • the means Adjustment 110 supports the feet 5 on the one hand and are connected to the columns 120 on the other hand, so as to allow a vertical movement of the device 100, and therefore a height adjustment, with the aid of slave motors 111.
  • the columns 120 have notches 121 which allow identical adjustment to the four corners of the device 100.
  • the columns 120 comprise an enlarged base 125 to ensure the stability of the assembly.
  • the presence of the columns 120 makes it possible to add another axis of movement of the device 100.
  • the adjustment means comprise adjustment wheels.
  • the number of arches may be different and the number of instrument holders on each arch.
  • the arches may be other than semicircles and have between their ends an angular difference greater than 180 °.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Animal Behavior & Ethology (AREA)
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  • Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Neurosurgery (AREA)
  • Surgical Instruments (AREA)

Abstract

The invention relates to a surgical device (100) comprising at least one arch (1) which is rotatable about an axis (R) and can be adjusted to a position about said axis, and at least one instrument carrier (30) movable along said at least one arch (1) and can be adjusted to a position on said arch.

Description

Dispositif chirurgical exocentrique  Exocentric surgical device
La présente invention se rapporte aux dispositifs utilisés en chirurgie robotisée. La chirurgie robotisée ne concerne encore qu'une gamme réduite d'opérations, par exemple les interventions via le péritoine, ou les opérations des cancers de la prostate.  The present invention relates to devices used in robotic surgery. Robotic surgery still only concerns a small range of operations, for example interventions via the peritoneum, or operations of prostate cancer.
Les autres chirurgies n'utilisent pas ou encore très peu de robot. Le besoin d'utiliser plus largement les robots chirurgicaux se heurte à plusieurs problèmes. Le frein principal est que la morphologie des robots généralement utilisés n'est pas adaptée pour travailler en microchirurgie.  Other surgeries do not use or very little robot. The need to use more widely the surgical robots faces several problems. The main brake is that the morphology of the robots generally used is not adapted to work in microsurgery.
Les équipements robotisés utilisés actuellement en chirurgie sont encombrants, lourds, coûteux, compliqués à installer et à maintenir. Leur utilisation requiert en outre un apprentissage de la part du chirurgien et de son équipe.  The robotic equipment currently used in surgery is bulky, heavy, expensive, complicated to install and maintain. Their use also requires learning from the surgeon and his team.
De façon classique, la chirurgie robotisée utilise une ouverture dans le corps du patient par laquelle passent les différents instruments. Un des besoins est de rendre la chirurgie la moins invasive possible pour limiter le traumatisme dû à l'opération et raccourcir le temps de cicatrisation.  Conventionally, robotic surgery uses an opening in the body of the patient through which the various instruments pass. One of the needs is to make the surgery the least invasive possible to limit the trauma due to the operation and to shorten the healing time.
Dans les robots utilisés actuellement en chirurgie, il est en particulier difficile de focaliser tous les instruments sur un même point et il n'est pas rare qu'en cours d'opération le point de focalisation se dérègle et que le chirurgien perde du temps à le retrouver et à ajuster de nouveau le positionnement des différents instruments.  In the robots currently used in surgery, it is particularly difficult to focus all the instruments on the same point and it is not uncommon that in the course of operation the focus point goes wrong and the surgeon loses time to find it and adjust the positioning of the different instruments again.
En neurologie, il est connu d'utiliser un dispositif de Leksell fixé sur la tête d'un patient. Par exemple la demande WO 2009/047494 décrit un guide pour instrument de neurochirurgie comportant un support arqué attaché à une base positionnée sur le crâne d'un patient. De tels systèmes stéréotaxiques sont également connus en radiothérapie pour positionner précisément un instrument radio-chirurgical non invasif vers la zone à traiter. Ces dispositifs ne sont pas adaptés à l'utilisation de plusieurs instruments focalisés sur une même zone.  In neurology, it is known to use a Leksell device attached to the head of a patient. For example the application WO 2009/047494 describes a guide for a neurosurgical instrument comprising an arched support attached to a base positioned on the skull of a patient. Such stereotaxic systems are also known in radiotherapy for precisely positioning a non-invasive radio-surgical instrument towards the area to be treated. These devices are not adapted to the use of several instruments focused on the same area.
H existe un besoin pour rendre les équipements de chirurgie robotisée plus petits, plus faciles à utiliser et moins onéreux et adaptés à des interventions chirurgicales de précision.  There is a need to make robotic surgery equipment smaller, easier to use and less expensive and suitable for precision surgical procedures.
II existe encore un intérêt pour faciliter et augmenter la rapidité du réglage en position des différents instruments lors d'une intervention chirurgicale robotisée.  There is still an interest in facilitating and increasing the speed of adjustment in position of the various instruments during a robotic surgical procedure.
L'invention a pour but de répondre à tout ou partie de ces besoins. Selon un premier aspect, l'invention a pour objet un dispositif chirurgical comportant au moins un arceau mobile en rotation autour d'un axe et réglable en position autour de cet axe et au moins un porte-instrument mobile le long dudit au moins un arceau et réglable en position sur celui-ci. The invention aims to meet all or part of these needs. According to a first aspect, the subject of the invention is a surgical device comprising at least one hoop rotatable about an axis and adjustable in position about this axis and at least one movable carrier along said at least one hoop and adjustable in position on it.
Le dispositif peut comporter un arceau unique ou un ensemble d'au moins deux arceaux relies entre eux, notamment traversés par un pivot d'axe correspondant à l'axe de rotation.  The device may comprise a single arch or a set of at least two arches interconnected, in particular traversed by a pivot axis corresponding to the axis of rotation.
Le porte-instrument peut être amovible.  The instrument holder can be removable.
Lors de l'utilisation du dispositif pour une intervention chirurgicale les porte- instruments peuvent porter directement un instrument chirurgical.  When using the device for a surgical procedure the instrument holders can directly carry a surgical instrument.
Dans le cadre de l'invention, le terme « instrument » doit être compris au sens large, pouvant signifier un élément comme un instrument chirurgical, une caméra, un système d'éclairage ou bien un trocart pour introduire un tel élément.  In the context of the invention, the term "instrument" must be understood in the broad sense, which may mean an element such as a surgical instrument, a camera, a lighting system or a trocar to introduce such an element.
Par exemple au moins un porte-instrument porte un trocart par lequel des instruments chirurgicaux ou une caméra sont introduits dans le corps du patient, en particulier tous les porte-instruments portent un trocart.  For example, at least one instrument holder carries a trocar by which surgical instruments or a camera are introduced into the body of the patient, in particular all the instrument holders carry a trocar.
L'invention permet le positionnement et le maintien en position des instruments tout au long d'une opération.  The invention allows the positioning and the holding in position of the instruments throughout an operation.
Grâce à l'invention tous les instruments peuvent converger vers un point central du champ opératoire visé par le chirurgien.  Thanks to the invention all the instruments can converge towards a central point of the operative field targeted by the surgeon.
Au moins un porte-instrument peut comporter des moyens d'actionnement en position de l'instrument qu'il porte, en particulier d'actionnement en hauteur par rapport au point d'intervention visé par le chirurgien. L'actionnement en hauteur peut correspondre à un mouvement de translation selon un axe du porte-instrument.  At least one instrument holder may comprise means for actuating the position of the instrument that it carries, in particular actuating at a height relative to the point of intervention targeted by the surgeon. The actuation height can correspond to a translational movement along an axis of the instrument holder.
Chaque porte-instrument peut ainsi comporter des moyens de positionnement de l'instrument axialement selon un axe propre.  Each instrument holder may thus comprise means for positioning the instrument axially along a proper axis.
Les axes de déplacement axial des porte-instruments peuvent se couper en un point fixe par rapport à le ou les arceaux, les axes pivotant autour dudit point en fonction des déplacements des arceaux et des porte-instruments.  The axes of axial displacement of the instrument holders can be cut at a fixed point relative to the or the arches, the axes pivoting around said point as a function of the movements of the arches and instrument holders.
Dans le cadre de la présente demande, on qualifie d'« exocentrique » un tel dispositif. Un dispositif exocentrique est particulièrement avantageux pour que le chirurgien lors d'une opération ne perde pas durablement la focalisation des instruments. Si le chirurgien souhaite quitter le point central de focalisation afin de travailler momentanément dans sa périphérie, l'invention peut lui permettre, comme expliqué plus loin, de revenir ensuite facilement à la position initiale. In the context of the present application, such a device is described as "exocentric". An exocentric device is particularly advantageous so that the surgeon during an operation does not permanently lose the focus of the instruments. If the surgeon wishes to leave the central focusing point to work momentarily in its periphery, the invention can allow it, as explained later, to then easily return to the initial position.
Ainsi, grâce à l'invention, tous les instruments peuvent facilement converger vers un point central correspondant au point de travail visé par le chirurgien.  Thus, thanks to the invention, all instruments can easily converge to a central point corresponding to the work point targeted by the surgeon.
Par ailleurs, alors que d'autres dispositifs de microchirurgie privilégient un accès global et relativement large au site opératoire pour permettre le passage des différents instruments, l'invention privilégie plusieurs incisions plus petites donc moins traumatisantes, plus rapides à cicatriser et moins sujettes à des infections.  Furthermore, while other microsurgical devices favor overall and relatively wide access to the operating site to allow the passage of the various instruments, the invention favors several smaller incisions that are less traumatic, faster to heal and less prone to infections.
Des variantes de réalisation peuvent présenter des dimensions variées. Alternative embodiments may have various dimensions.
L'invention facilite en particulier les interventions au niveau des membres inférieurs ou supérieurs, par exemple une opération de la main ou du bras. The invention facilitates in particular the interventions at the level of the lower or upper limbs, for example an operation of the hand or the arm.
Des dispositifs de plus grandes dimensions sont adaptés à des opérations de la tête et des dimensions plus importantes d'un dispositif selon l'invention peuvent permettre des interventions sur d'autres parties du corps, par exemple le thorax.  Larger devices are suitable for head operations and larger dimensions of a device according to the invention may allow interventions on other parts of the body, for example the thorax.
Châssis du dispositif  Device chassis
Le dispositif peut comporter un châssis solidaire de l'arceau ou des arceaux. Celui-ci est, respectivement ceux-ci sont par exemple mobile(s) par rapport audit châssis, en particulier en translation le long d'un axe.  The device may comprise a frame integral with the arch or hoops. This is, respectively these are for example mobile (s) relative to said frame, in particular in translation along an axis.
Le châssis comporte par exemple deux glissières parallèles portées par un bâti et le long desquelles se déplacent le ou les arceaux.  The frame comprises for example two parallel rails carried by a frame and along which move or the arches.
Le châssis peut être configuré pour pouvoir reposer, en particulier être fixé fermement, sur une table d'opération de façon à choisir l'orientation de l'axe de rotation des arceaux, en particulier horizontale ou verticale. Le châssis peut être configuré pour pouvoir reposer et être fixé sur une table d'opération de telle sorte que l'axe de déplacement du ou des arceaux soit orienté horizontalement ou verticalement.  The frame can be configured to be able to rest, in particular to be fixed firmly, on an operating table so as to choose the orientation of the axis of rotation of the arches, in particular horizontal or vertical. The frame can be configured to be able to rest and be fixed on an operating table so that the axis of movement of the bow or hoops is oriented horizontally or vertically.
Le bâti peut comprendre deux pieds, en particulier de forme allongée, reliés par les deux glissières parallèles. La forme allongée des pieds permet avantageusement une plus grande variation angulaire dans le positionnement des arceaux. Les pieds peuvent être configurés pour offrir plusieurs positions possibles du dispositif sur la table d'opération. Le dispositif peut par exemple reposer sur des grands côtés des pieds, ou des petits côtés ou sur une face externe d'un des pieds. En variante, les pieds peuvent être configurés pour reposer sur une base réglable en hauteur, comportant par exemple des colonnes et des moyens de réglage permettant d'ajuster la hauteur des pieds le long des colonnes. Les moyens de réglage peuvent par exemple comprendre des moteurs asservis ou des molettes de réglage. The frame may comprise two feet, in particular of elongated shape, connected by the two parallel rails. The elongated shape of the legs advantageously allows greater angular variation in the positioning of the hoops. The feet can be configured to provide several possible positions of the device on the operating table. The device may for example rest on long sides of the feet, or small sides or on an outer face of one of the feet. Alternatively, the feet can be configured to rest on a height-adjustable base, comprising for example columns and adjustment means for adjusting the height of the feet along the columns. The adjustment means may for example comprise servo motors or adjusting wheels.
Le châssis peut en outre comporter au moins un moyen de fixation mobile selon un deuxième axe, notamment perpendiculaire à l'axe de déplacement du ou des arceaux, le moyen de fixation étant configuré pour recevoir, de façon amovible ou non, une tablette agencée pour porter un support pour la partie à opérer d'un patient.  The chassis may further comprise at least one movable fastening means along a second axis, in particular perpendicular to the axis of displacement of the arch or hoops, the fastening means being configured to receive, removably or not, a tablet arranged for carry a support for the part to operate of a patient.
Le moyen de fixation de la tablette comporte par exemple deux coulisseaux mobiles le long de glissières du châssis allongées selon le deuxième axe.  The fixing means of the shelf comprises for example two movable slides along elongated chassis rails along the second axis.
Déplacement et focalisation des instruments chirurgicaux  Displacement and focus of surgical instruments
Un porte-instrument est configuré pour être monté sur un arceau, conférant aux instruments correspondant plusieurs degrés de liberté.  An instrument holder is configured to be mounted on an arch, giving the corresponding instruments several degrees of freedom.
Un porte-instrument peut comporter des premiers moyens de positionnement sur un arceau. Un porte instrument peut être fixé dans une position particulière sur l'arceau par encliquetage, serrage autour de l' arceau...cette liste étant non limitative. Les premiers moyens de positionnement utilisés peuvent être de type connu de l'homme du métier et comporter par exemple une mâchoire à serrer sur l'arceau ou une vis de pression.  An instrument holder may comprise first positioning means on a hoop. An instrument holder can be fixed in a particular position on the hoop by snapping, clamping around the hoop ... this list being nonlimiting. The first positioning means used may be of a type known to those skilled in the art and comprise, for example, a jaw to be clamped on the hoop or a set screw.
Au moins un arceau pivote autour de l'axe de rotation, selon un premier mouvement de rotation.  At least one hoop pivots about the axis of rotation, according to a first rotational movement.
Un arceau, voire tous les arceaux, peuvent présenter une forme incurvée comprise dans un plan.  A hoop, or all the hoops, may have a curved shape included in a plane.
Le déplacement de chaque porte instrument peut être compris dans un plan défini par l'arceau correspondant.  The movement of each instrument carrier can be included in a plane defined by the corresponding arch.
De préférence, chaque porte-instrument est mobile le long de l'arceau qui le supporte selon un second mouvement de rotation. Au moins un des arceaux a par exemple la forme d'un arc de cercle, en particulier d'un demi-cercle.  Preferably, each carrier is movable along the hoop which supports it in a second rotational movement. At least one of the arches has for example the shape of an arc of a circle, in particular of a semicircle.
Dans une variante un arceau forme un anneau complet. De préférence, tous les arceaux ont la forme d'un arc de cercle, en particulier d'un demi-cercle. In a variant, a bow forms a complete ring. Preferably, all the arches have the shape of an arc of a circle, in particular of a semicircle.
L'arceau peut être configuré pour faciliter le déplacement du porte-instrument le long de l'arceau et empêcher le porte-instrument de pivoter autour de l'arceau. La section d'un arceau, voire de tous les arceaux, est par exemple aplatie, ayant notamment une forme rectangulaire ou carrée. Dans une variante un arceau est composé de plusieurs tubes, par exemple deux tubes circulaires de section identique ou différente, formant une structure géométrique s'apparentant à des rails.  The hoop may be configured to facilitate movement of the implement holder along the hoop and to prevent the hilt from pivoting around the hoop. The section of an arch, or all of the arches, is for example flattened, having in particular a rectangular or square shape. In a variant a hoop is composed of several tubes, for example two circular tubes of identical or different section, forming a geometric structure similar to rails.
Un porte-instrument peut comporter des deuxièmes moyens de positionnement configurés pour régler la position de l'instrument par rapport au porte instrument correspondant. Les deuxièmes moyens de positionnement peuvent comporter un système de serrage par mâchoires ou vis de pression permettant un réglage axial du trocart.  An instrument holder may comprise second positioning means configured to adjust the position of the instrument relative to the corresponding instrument holder. The second positioning means may comprise a clamping system by jaws or pressure screws for axial adjustment of the trocar.
Le mouvement de translation de l'instrument est par exemple parallèle au plan de déplacement du porte-instrument sur l ' arceau.  The translational movement of the instrument is for example parallel to the plane of movement of the instrument holder on the arch.
De façon alternative ou complémentaire, l'axe du mouvement de translation du porte-instrument peut passer par le centre du mouvement de rotation du porte-instrument sur l'arceau correspondant.  Alternatively or additionally, the axis of the translational movement of the instrument holder can pass through the center of the rotational movement of the instrument holder on the corresponding arch.
Dans un mode de réalisation, de façon alternative ou complémentaire, l'instrument peut avoir un mouvement de rotation par rapport au porte instrument qui le porte ce qui ajoute un axe de mouvement supplémentaire. L'instrument peut ainsi avoir la possibilité de rotation sur lui-même.  In an embodiment, alternatively or additionally, the instrument may have a rotational movement relative to the instrument holder which carries it, which adds an additional axis of movement. The instrument can thus have the possibility of rotation on itself.
Le dispositif chirurgical selon l'invention peut ainsi offrir au moins trois degrés de liberté pour le positionnement des instruments chirurgicaux sans bouger le point central de travail.  The surgical device according to the invention can thus offer at least three degrees of freedom for the positioning of surgical instruments without moving the central point of work.
Dans un mode de réalisation particulier, un léger déplacement du porte- instrument permet de quitter le point central de focalisation afin de travailler dans sa périphérie. Le porte-instrument peut par exemple offrir deux degrés de liberté supplémentaire au trocart ou à l'instrument qu'il porte. Le porte-instrument peut ainsi permettre une légère rotation et/ou translation du trocart ou de l'instrument. Le porte- instrument peut ainsi définir deux axes de rotation supplémentaires.  In a particular embodiment, a slight movement of the instrument holder makes it possible to leave the central focusing point in order to work in its periphery. The instrument holder can for example offer two degrees of freedom additional trocar or the instrument that carries. The instrument holder can thus allow a slight rotation and / or translation of the trocar or the instrument. The instrument holder can thus define two additional axes of rotation.
Lorsque l'ensemble d'arceaux est mobile relativement à la partie opérée du corps du patient comme décrit précédemment, le dispositif chirurgical peut offrir encore un ou deux degrés de libertés supplémentaires pour le positionnement relatif du ou des arceaux et du site opératoire. When the set of arches is movable relative to the operated part of the patient's body as previously described, the surgical device can still offer a or two additional degrees of freedom for the relative positioning of the arch or arches and the operative site.
Déplacement  displacement
Le déplacement des différents éléments du dispositif afin de régler leurs positions relatives respectives ainsi que leur position par rapport au champ opératoire peut être effectué manuellement.  The displacement of the various elements of the device in order to adjust their respective relative positions as well as their position relative to the operating field can be performed manually.
En particulier pour déplacer et maintenir en position au moins l'un des arceaux et/ou l'un des porte-instrument par rapport à un arceau, le dispositif peut comporter un système d'actionnement.  In particular to move and hold in position at least one of the arches and / or one of the instrument holder with respect to a hoop, the device may comprise an actuating system.
Ce dernier peut commander des déplacements d'un trocart ou d'un instrument logé dans un porte-instrument.  The latter can control movements of a trocar or instrument housed in an instrument holder.
Dans une variante, le système d'actionnement commande des déplacements d'une tablette pour support d'un membre à opérer.  In a variant, the actuation system controls the movements of a tablet for supporting a limb to be operated.
Le système d'actionnement peut comporter un actionneur mécanique ou électromécanique permettant un déplacement avec un réglage submillimétrique des positions des différents éléments du dispositif (arceaux, porte-instruments et/ou instruments).  The actuating system may comprise a mechanical or electromechanical actuator allowing displacement with a submillimetric adjustment of the positions of the various elements of the device (arches, instrument holders and / or instruments).
Le système d'actionnement peut être motorisé et comporter par exemple des moteurs pas à pas pour permettre d'effectuer, au moins en partie, les rotations et les translations nécessaires aux mouvements des instruments. Le système d'actionnement peut comporter des motoréducteurs.  The actuating system can be motorized and include for example stepper motors to allow to perform, at least in part, the rotations and translations necessary for the movements of the instruments. The actuation system may comprise geared motors.
Les arceaux peuvent être crantés formant ainsi une crémaillère sur laquelle peut se déplacer un porte instrument équipé d'un engrenage notamment motorisé.  The hoops can be notched thus forming a rack on which can move an instrument holder equipped with a gear motorized particular.
Le système d'actionnement peut être configuré pour déplacer et maintenir en position tous les instruments portés par un porte-instrument et chaque porte-instrument sur l'arceau correspondant. Dans une variante, le système d'actionnement commande les mouvements des arceaux les uns par rapport aux autres ainsi que ceux de l'ensemble des arceaux par rapport au membre à opérer.  The actuating system can be configured to move and hold in position all the instruments carried by an instrument holder and each instrument holder on the corresponding arch. In a variant, the actuation system controls the movements of the arches relative to each other as well as those of the set of arches relative to the member to be operated.
De préférence, le système d'actionnement est configuré pour commander les déplacements par rapport au châssis d'une éventuelle tablette pour support d'un membre à opérer. Le système d'actionnement peut être piloté à distance par un système télécommandé, notamment via une liaison sans fil. Preferably, the actuating system is configured to control the movements relative to the frame of a possible tablet for supporting a member to operate. The actuation system can be controlled remotely by a remote control system, in particular via a wireless link.
Le dispositif peut comporter un système de sécurité, notamment un système de freins, qui permet de verrouiller au moins un degré de liberté, voire tous.  The device may include a security system, including a brake system, which locks at least one degree of freedom, or all.
Par un système de sécurité, on entend tout moyen pour empêcher un déplacement relatif involontaire et/ou incontrôlé des différents éléments du dispositif.  By a security system means any means to prevent involuntary and / or uncontrolled relative movement of the various elements of the device.
Le système de sécurité fonctionne par exemple par friction des composants mobiles entre eux. Dans une variante, le système de sécurité comporte simplement l'asservissement des moteurs pour lesquels on programme un courant de maintien  The security system operates for example by friction of moving components between them. In a variant, the safety system simply comprises the servocontrol of the motors for which a maintenance current is programmed
Le dispositif peut être gradué afin de faciliter le positionnement de chaque composant. En particulier, le dispositif peut présenter une échelle de graduation pour chaque degré de liberté. Par exemple, un arceau, voire chaque arceau comporte une échelle graduée et/ou est cranté.  The device can be graduated to facilitate the positioning of each component. In particular, the device may have a scale of graduation for each degree of freedom. For example, a hoop or even each hoop has a graduated scale and / or is notched.
Chaque porte-instrument peut être gradué et/ou cranté.  Each holder can be graduated and / or notched.
Le châssis peut comporter une échelle graduée selon chaque axe de déplacement du ou des arceaux ou du moyen de fixation pour tablette. Cette graduation peut être visuelle et/ou électronique grâce à un codeur connu de l'homme du métier, par exemple une roue codeuse ou un pied à coulisse électronique.  The frame may comprise a scale graduated according to each axis of movement of the arch or bars attachment means. This graduation can be visual and / or electronic thanks to an encoder known to those skilled in the art, for example an encoder wheel or an electronic caliper.
Arceaux  hoops
Un arceau peut porter simultanément plusieurs porte-instruments. A hoop can carry several instrument holders simultaneously.
Le nombre d'arceaux et le nombre de porte-instruments ne sont pas limités, seul l'encombrement des porte-instruments et des instruments chirurgicaux fixés sur le dispositif peut être une restriction car selon les besoins, le praticien doit pouvoir modifier la position relative des instruments en cours d'intervention. The number of arches and the number of instrument holders are not limited, only the size of the instrument holders and surgical instruments attached to the device may be a restriction because, depending on the needs, the practitioner must be able to modify the relative position. instruments in the process of intervention.
Le dispositif comporte par exemple entre un et six arceaux, notamment deux, trois ou quatre arceaux.  The device comprises for example between one and six arches, including two, three or four arches.
L'arceau est par exemple fixé à au moins un moyeu mobile autour de l'axe de rotation, voire à deux moyeux diamétralement opposés par rapport à l'arceau.  The hoop is for example fixed to at least one hub movable about the axis of rotation, or to two hubs diametrically opposite with respect to the hoop.
Chaque arceau du dispositif peut comporter deux extrémités, au moins une, voire chacune étant par exemple terminée par le moyeu mobile autour de l'axe de rotation des arceaux. Dans une variante le dispositif comporte un seul arceau, notamment formant un cercle complet, par exemple solidaire d'un moyeu mobile autour de l'axe de rotation. Each arch of the device may comprise two ends, at least one or even each being for example terminated by the movable hub about the axis of rotation of the hoops. In a variant the device comprises a single hoop, in particular forming a complete circle, for example secured to a hub movable about the axis of rotation.
Au moins un arceau, voire chaque arceau, peut présenter une forme incluse dans un plan, c'est-à-dire que le porte-instrument correspondant se déplace dans un plan. Le plan de déplacement du porte instrument peut être parallèle à l'axe de déplacement de l'instrument à l'intérieur du porte-instrument et/ou passer par l'axe de rotation de l'arceau.  At least one arch, or even each arch, may have a shape included in a plane, that is to say that the corresponding instrument holder moves in a plane. The plane of movement of the instrument holder may be parallel to the axis of movement of the instrument inside the instrument holder and / or through the axis of rotation of the arch.
Dans une première variante de réalisation le plan de déplacement du porte- instrument est parallèle à Taxe de rotation de l'arceau correspondant dont il est distant d'une distance non nulle.  In a first variant embodiment, the plane of movement of the instrument holder is parallel to the axis of rotation of the corresponding arch from which it is distant from a non-zero distance.
En particulier le plan de déplacement du porte-instrument peut être tangent au moyeu, la distance entre l'axe de rotation de l'arceau et ledit plan étant égale au rayon du moyeu. L'axe de déplacement de l'instrument sur le porte-instrument est alors par exemple parallèle à ce plan et distant du plan d'une distance égale au rayon du moyeu, l'instrument et le centre du moyeu se trouvant du même côté du plan de déplacement du porte- instrument  In particular the plane of movement of the instrument holder may be tangent to the hub, the distance between the axis of rotation of the hoop and said plane being equal to the radius of the hub. The axis of movement of the instrument on the instrument holder is then for example parallel to this plane and distant from the plane by a distance equal to the radius of the hub, the instrument and the center of the hub being on the same side of the plane of movement of the instrument holder
Dans une deuxième variante de réalisation le plan de déplacement du porte- instrument contient l'axe de rotation des arceaux. L'axe de déplacement de l'instrument sur le porte-instrument est alors par exemple incliné par rapport à ce plan et, de préférence, pivote autour d'un point central fixe du dispositif lorsque le porte-instrument est déplacé le long de l'arceau le supportant.  In a second variant embodiment the plane of movement of the instrument holder contains the axis of rotation of the arches. The axis of movement of the instrument on the instrument holder is then inclined for example with respect to this plane and, preferably, pivots around a fixed central point of the device when the instrument holder is moved along the arch supporting it.
Les arceaux peuvent être solidaires, étant notamment reliés entre eux au niveau de leur moyeu.  The arches may be integral, being in particular interconnected at their hub.
Les moyeux d'une même extrémité des arceaux sont par exemple traversés par un axe sous forme de pivot, par exemple un pivot central.  The hubs of the same end of the hoops are for example traversed by a pin-shaped axis, for example a central pivot.
Les moyeux peuvent présenter des formes qui se correspondent ou non.  The hubs may have shapes that correspond or not.
Au moins un arceau peut être totalement libre autour de l'axe de rotation, au moins lorsqu'il ne porte aucun porte-instrument, c'est-à-dire qu'il peut tourner de 360° sur lui-même, indépendamment de l'orientation des autres arceaux. L'encombrement d'un ou de plusieurs instruments peut gêner une telle rotation dans une configuration particulière.  At least one arch may be completely free around the axis of rotation, at least when it carries no instrument holder, that is to say it can rotate 360 ° on itself, independently of the orientation of the other arches. The size of one or more instruments may interfere with such rotation in a particular configuration.
Porte-instrument et porte caméra  Holder and camera door
Le porte-instrument peut porter, directement ou non, une caméra et/ou un système d'écartement des chairs pour dégager un espace opératoire sous-cutané. Lorsqu'un porte-instrument porte un système d'écartement, le chirurgien règle l'orientation de l'axe du porte-instrument et la hauteur du système d'écartement pour que l'espace sous-cutané dégagé soit suffisant. The instrument holder can carry, directly or not, a camera and / or a system of separation of the flesh to clear a subcutaneous operating space. When an instrument holder carries a spacer system, the surgeon adjusts the orientation of the axis of the instrument holder and the height of the spacer system so that the subcutaneous space cleared is sufficient.
Dans une variante le dispositif chirurgical comporte une caméra fixée directement sur un arceau et non sur un porte-instrument. Le chirurgien règle la position de la caméra par rapport au site opératoire en fixant la position de la caméra sur l'arceau correspondant.  In a variant, the surgical device comprises a camera attached directly to a hoop and not to an instrument holder. The surgeon adjusts the position of the camera relative to the operating site by fixing the position of the camera on the corresponding arch.
Dans une variante préférentielle la caméra et les instruments sont portés par un arceau. Plus généralement, le chirurgien règle la position de l'instrument par rapport au site opératoire en fixant la position du porte-instrument sur l'arceau correspondante et celle de l'instrument par rapport au porte-instrument.  In a preferred embodiment, the camera and the instruments are carried by an arch. More generally, the surgeon adjusts the position of the instrument relative to the operating site by fixing the position of the instrument holder on the corresponding arch and that of the instrument relative to the instrument holder.
Chaque porte-instrument peut être amovible.  Each instrument holder can be removable.
Utilisation avec pointeur laser  Use with laser pointer
Le dispositif chirurgical peut comporter un pointeur laser pour faciliter le réglage en position des différents composants du dispositif par rapport à la partie à opérer du patient.  The surgical device may comprise a laser pointer to facilitate the adjustment in position of the various components of the device relative to the part to be operated on by the patient.
Le praticien ou son assistant peut fixer un ou des marqueurs, notamment radio- opaques, sur le membre à opérer. De préférence les marqueurs sont au moins au nombre de trois. Dans une variante il utilise de façon alternative ou complémentaire des repères morphologiques.  The practitioner or his assistant can fix one or more markers, in particular radiopaque markers, on the limb to be operated. Preferably the markers are at least three in number. In a variant it uses alternately or complementary morphological landmarks.
On réalise ensuite au moins une image par imagerie médicale, en particulier de type scanner ou/et IRM afin de déterminer le point de focalisation de la chirurgie puis de choisir les vecteurs de pénétration des instruments.  At least one image is then made by medical imaging, in particular of scanner or / and MRI type in order to determine the point of focus of the surgery and then to choose the vectors of penetration of the instruments.
Le dispositif peut être agencé pour calculer, à partir de ce point sélectionné, par un algorithme la position de chaque composant du dispositif (arceau, porte-instruments, support) afin d'orienter les instruments vers le point à traiter.  The device can be arranged to calculate, from this selected point, by an algorithm the position of each component of the device (hoop, instrument holder, support) in order to orient the instruments towards the point to be treated.
Le chirurgien règle en position le dispositif et positionne le membre sur le support. En se repérant à l'aide des points radio-opaques du membre et du pointeur laser, le chirurgien effectue ensuite les différents réglages manuellement.  The surgeon adjusts the device in position and positions the limb on the support. By locating with the radio-opaque points of the limb and the laser pointer, the surgeon then makes the various adjustments manually.
Dans une variante les coordonnées cartésiennes obtenues par l'imagerie médicale sont traduites en coordonnées polaires suivant un protocole du dispositif et les réglages se font ensuite automatiquement. Chaque axe de porte-instrument est positionné pour viser une zone correspondante à inciser pour entrer le trocart, rinstrument ou la caméra dans la zone à opérer. In one variant, the Cartesian coordinates obtained by the medical images are translated into polar coordinates according to a protocol of the device and the settings are then done automatically. Each holder shaft is positioned to aim at a corresponding area to incise to enter the trocar, instrument or camera into the area to be operated.
Selon encore un autre aspect, l'invention a pour objet un procédé de calcul et/ou de réglage de la position des instruments chirurgicaux, notamment lors d'une intervention laparoscopique, de diagnostic ou de chirurgie, par exemple des membres inférieurs ou supérieurs ..., utilisant un dispositif chirurgical selon l'invention.  According to yet another aspect, the subject of the invention is a method for calculating and / or adjusting the position of surgical instruments, in particular during a laparoscopic, diagnostic or surgical procedure, for example lower or upper limbs. .., using a surgical device according to the invention.
En cours d'opération il est souvent nécessaire, pour obtenir de façon constante une bonne position, à la fois des instruments cliirurgicaux, de l'éclairage et de la caméra, d'ajuster plusieurs fois les positions respectives des composants du dispositif Le procédé à l'aide d'un dispositif tel que décrit permet un réglage plus rapide et plus fiable.  During operation, it is often necessary, in order to constantly obtain a good position, both surgical instruments, lighting and the camera, to adjust several times the respective positions of the components of the device. using a device as described allows a faster and more reliable adjustment.
L'invention pourra être mieux comprise à la lecture de la description détaillée qui va suivre, d'exemples de mise en œuvre non limitatifs de celle-ci, et à l'examen du dessin annexé, sur lequel :  The invention will be better understood on reading the detailed description which follows, examples of non-limiting implementation thereof, and on examining the appended drawing, in which:
- les figures 1 et 2 illustrent en perspective et de côté un exemple de réalisation de dispositif chirurgical selon l'invention,  FIGS. 1 and 2 illustrate in perspective and from the side an exemplary embodiment of a surgical device according to the invention,
les figures 3 à 5 représentent divers orientations et positionnements de dispositifs chirurgicaux selon l'invention,  FIGS. 3 to 5 show various orientations and positioning of surgical devices according to the invention,
les figures 6 et 7 illustrent de façon isolée et en perspective des variantes de porte-instrument,  FIGS. 6 and 7 illustrate, in isolation and in perspective, variants of the instrument carrier,
la figure 8 illustre un dispositif chirurgical selon rinvention lors d'une opération du poignet,  FIG. 8 illustrates a surgical device according to the invention during a wrist operation,
la figure 9 représente en perspective un autre exemple de réalisation de dispositif chirurgical selon l'invention,  FIG. 9 is a perspective view of another embodiment of a surgical device according to the invention,
- les figures 10A à 10E illustrent en coupe différents arceaux, et la figure 11 illustre de manière schématique et en perspective, un autre exemple de réalisation du dispositif chirurgical selon l'invention.  - Figures 10A to 10E illustrate in section different arches, and Figure 11 illustrates schematically and in perspective, another embodiment of the surgical device according to the invention.
La figure 1 représente un dispositif 100 selon l'invention comportant un ensemble 10 de trois arceaux 1, chacun terminé à ses deux extrémités par un moyeu 2 mobile autour du même axe de rotation R. Les arceaux 1 sont solidaires au niveau des moyeux 2 qui sont dans l'exemple illustré traversés par un pivot central 20. Au moins un arceau 1 est totalement libre en rotation autour de l'axe R, c'est- à-dire qu'il peut pivoter de 360°, dans l'exemple illustré, l'arceau 1 portant le trocart 150 de caméra 140. FIG. 1 represents a device 100 according to the invention comprising an assembly 10 of three hoops 1, each terminated at its two ends by a hub 2 movable about the same axis of rotation R. The hoops 1 are integral at the hubs 2 which are in the illustrated example traversed by a central pivot 20. At least one hoop 1 is completely free to rotate about the axis R, that is to say that it can rotate 360 °, in the example shown, the hoop 1 carrying the trocar 150 camera 140 .
Dans l'exemple illustré, chaque arceau 1 a la forme d'un demi-cercle et définit un plan PA tangent aux moyeux 2 et distant de l'axe R d'une distance D. In the illustrated example, each arch 1 has the shape of a semicircle and defines a plane P A tangential to the hubs 2 and remote from the axis R by a distance D.
Chaque arceau 1 porte un porte-instrument 30 configuré pour se déplacer dans le plan PA par un mouvement circulaire d'un angle β mesuré à partir de l'axe R le long de l'arceau 1 correspondante. Les porte-instruments du dispositif illustré portent ainsi un trocart 150 pour le passage d'un instrument chirurgical 135 ou d'une caméra 140. Each arch 1 carries an instrument holder 30 configured to move in the plane P A by a circular motion of an angle β measured from the axis R along the corresponding arch 1. The instrument holders of the illustrated device thus carry a trocar 150 for the passage of a surgical instrument 135 or a camera 140.
Dans une variante non illustrée, un des porte-instruments 30 porte un système d'écartement des chairs.  In a variant not shown, one of the instrument holders 30 carries a system of separation of the flesh.
Chaque porte-instrument définit un axe Z de déplacement du trocart 150, les axes Z se coupent en un point O.  Each holder defines a Z axis of movement of the trocar 150, the Z axes intersect at a point O.
Pour chaque porte-instrument, l'axe Z est parallèle à PA, situé à une distance d et du même côté de PA que le moyeu 2 de l'arceau 1 correspondant. Les distances D et d se compensent pour que le point O reste fixe par rapport à l'ensemble 10 indépendamment de la position des arceaux 1 et des porte-instruments 30 sur les arceaux. Le dispositif illustré est exocentrique au sens de l'invention, For each instrument holder, the Z axis is parallel to P A , located at a distance d and on the same side of P A as the hub 2 of the corresponding arch 1. The distances D and d compensate for the point O remains fixed relative to the assembly 10 regardless of the position of the arches 1 and the instrument holders 30 on the arches. The illustrated device is exocentric within the meaning of the invention,
Dans une autre variante non représentée d'un dispositif exocentrique, les plans PA des différents arceaux sont sécants en l'axe de rotation R et les axes Z forment un angle non nul par rapport au plan PA. In another variant, not shown, of an exocentric device, the planes P A of the different hoops are intersecting in the axis of rotation R and the axes Z form a non-zero angle with respect to the plane P A.
Le dispositif 100 comporte en outre un système d'actionnement motorisé 80 comprenant des motoréducteurs 85, notamment pas à pas ou à courant continu, fixés au niveau des moyeux 2 afin de contrôler le déplacement de l'ensemble 10 fixé sur les coulisseaux 15 selon l'axe X et la rotation autour de l'axe R de chaque arceau 1, respectivement sur chaque porte instrument 30 pour contrôler le déplacement du porte- instrument le long de l'arceau 1 qui le porte ainsi que les déplacements de l'instrument à l'intérieur du porte-instrument 30.  The device 100 further comprises a motorized actuation system 80 comprising geared motors 85, in particular stepwise or direct current, fixed at the hubs 2 in order to control the displacement of the assembly 10 fixed on the sliders 15 according to FIG. X axis and the rotation about the axis R of each arch 1, respectively on each instrument holder 30 to control the movement of the instrument holder along the arch 1 which carries it and the movements of the instrument to inside the instrument holder 30.
Les motoréducteurs 85 sont commandés à distance via une liaison filaire ou sans fil par un système d'actionnement non représenté. Le système d'actionnement comporte également un système de freins non illustré afin de sécuriser la position de l'ensemble 10, des arceaux 1, des porte-instruments 30 et des trocarts. The geared motors 85 are remotely controlled via a wired or wireless connection by an actuation system, not shown. The actuation system also includes a brake system not shown to secure the position of the assembly 10, arches 1, instrument holders 30 and trocars.
Lors d'une opération, le chirurgien peut commencer par prédéfinir, en fonction de l'opération concernée, l'orientation des arceaux 1 par rotation d'angle a autour de l'axe R, chaque arceau 1 pivotant autour de l'axe R selon la double flèche A illustrée figure 2. Ensuite, le praticien déplace les porte-instruments 30 le long des arceaux 1 d'une façon circulaire suivant la double flèche B de la figure 1. Les porte-instruments sont ainsi prépositionnés de façon à limiter l'encombrement global lorsque les instruments et la caméra sont mis en place pour que des mouvements ultérieurs des arceaux ou des porte- instruments soient possibles en cours d'opération sans que les porte-instruments ou les instruments se gênent les uns les autres.  During an operation, the surgeon can begin by predefining, depending on the operation concerned, the orientation of the arches 1 by rotation of angle around the axis R, each arch 1 pivoting about the axis R according to the double arrow A illustrated in FIG. 2. Then, the practitioner moves the instrument holders 30 along the arches 1 in a circular manner along the double arrow B of FIG. 1. The instrument holders are thus prepositioned so as to limit the overall size when the instruments and the camera are set up so that subsequent movements of the arches or instrument holders are possible during operation without the instrument holders or instruments interfering with each other.
Les angles a et β peuvent être déterminés par un algorithme et les rotations correspondantes effectuées grâce au système d'actionnement motorisé  The angles a and β can be determined by an algorithm and the corresponding rotations performed by means of the motorized actuation system
Les préréglages des angles a et β sont par exemple calculés par l'algorithme à partir d'images du membre par imagerie médicale. Le praticien utilise par exemple un ou plusieurs marqueurs radio-opaque positionnés sur le membre à opérer ou des repères morphologiques.  The presets of the angles a and β are for example calculated by the algorithm from images of the limb by medical imaging. The practitioner uses, for example, one or more radiopaque markers positioned on the limb to be operated or morphological markers.
Le chirurgien règle également la hauteur des trocarts, instruments ou caméra dans chaque porte-instruments 30 le long de l'axe Z par un mouvement rectiligne selon la double flèche C de la figure 2.  The surgeon also adjusts the height of the trocars, instruments or camera in each carrier 30 along the Z axis by a rectilinear movement along the double arrow C of FIG.
Les mouvements selon A, B et C permettent de mouvoir chaque instrument 135 sans bouger le point central de focalisation O.  The movements according to A, B and C make it possible to move each instrument 135 without moving the central focusing point O.
Tous les degrés de liberté sont verrouillables par un système de frein, par exemple de frein hydraulique, pneumatique ou électromécanique  All degrees of freedom are lockable by a brake system, for example a hydraulic, pneumatic or electromechanical brake
Le dispositif pré-positionné repose sur la table d'opération par l'intermédiaire de deux pieds 5 allongés et parallèles d'un châssis 50.  The pre-positioned device rests on the operating table by means of two elongated and parallel feet 5 of a frame 50.
Dans l'exemple illustré, le dispositif chirurgical comporte optionnellement une tablette 60 destinée à recevoir le membre à opérer, par exemple une main. La tablette 60 est notamment munie d'un support 62.  In the example illustrated, the surgical device optionally comprises a tablet 60 for receiving the member to operate, for example a hand. The tablet 60 is in particular provided with a support 62.
Suivant le type d'intervention chirurgicale, le support 62, voire la tablette 60, peuvent s'avérer nécessaires ou non. Le chirurgien règle également le positionnement de l'ensemble 10 des arceaux 1 selon l'axe X par déplacement des coulisseaux 15 sur des glissières 16 ainsi que le positionnement selon l'axe Y d'une tablette 60 fixée de façon amovible sur le châssis 50 à l'aide des coulisseaux 65 mobiles le long des glissières 66. Depending on the type of surgical procedure, the support 62, or even the tablet 60, may be necessary or not. The surgeon also sets the positioning of the assembly 10 of the arches 1 along the X axis by moving the slides 15 on the slides 16 and the positioning along the Y axis of a tablet 60 removably attached to the frame 50 using the slides 65 movable along the slides 66.
Dans l'exemple non limitatif illustré les coulisseaux de fixation 15 et 65 coulissent sur glissières 16 et 66 en forme de barres. Dans un exemple non illustré les coulisseaux se déplacent le long de rails.  In the nonlimiting example illustrated, the fixing slides 15 and 65 slide on rails 16 and 66 in the form of bars. In an example not shown, the slides move along rails.
Le dispositif 100 illustré figure 3 ne comporte que deux arceaux 1 et un seul porte-instrument 30.  The device 100 illustrated in FIG. 3 comprises only two arches 1 and one single instrument holder 30.
Alors que le dispositif chirurgical illustré aux figures 1 et 2 est positionné sur la table d'opération de façon à reposer sur les plus grands côtés des pieds 5 du châssis 50, l'ensemble 10 des arceaux 1 étant mobile par rapport au châssis 50 selon l'axe X qui est horizontal, dans la configuration de la figure 4, l'axe X est vertical. Les arceaux 1 sont par exemple positionnés au-dessus de la zone prévue pour introduire le membre à opérer. Indépendamment, le dispositif illustré figure 4 ne comporte pas de tablette 60 fixée sur les coulisseaux 15 mobiles selon l'axe Y qui coulissent le long des glissières 66.  While the surgical device illustrated in Figures 1 and 2 is positioned on the operating table so as to rest on the longer sides of the legs 5 of the frame 50, the assembly 10 of the hoops 1 being movable relative to the frame 50 according to the X axis is horizontal, in the configuration of Figure 4, the X axis is vertical. The arches 1 are for example positioned above the area provided for introducing the member to operate. Independently, the device illustrated in FIG. 4 does not include a shelf 60 fixed on the slides 15 movable along the Y axis which slide along the slides 66.
La figure 5 montre une autre variante de positionnement d'un dispositif 100 sans tablette et reposant sur les plus grands côtés des pieds 5 du châssis 50 placé sur une table d'opération. Les arceaux 1 sont réglés au dessus et respectivement au dessous du site opératoire de façon à entourer le membre à opérer non représenté.  Figure 5 shows another alternative positioning of a device 100 without a tablet and resting on the longer sides of the legs 5 of the frame 50 placed on an operating table. The arches 1 are set above and below the operative site so as to surround the member to be operated not shown.
Comme le montrent les figures 4 et 5, l'absence de tablette 60 permet une plus grande variation angulaire dans le positionnement des arceaux 1.  As shown in Figures 4 and 5, the absence of tablet 60 allows greater angular variation in the positioning of the arches 1.
La figure 6 illustre une variante de porte-instrument 30 comportant une partie de fixation 33 creuse comportant une fente de forme et de section correspondant à l'arceau 1 de façon à coulisser le long de celui-ci et un corps 32 traversé par un logement ouvert dans lequel peut être inséré et/ou coulisser un trocart 150. Le porte instrument 30 est maintenu par friction dans la position voulue le long de l'arceau 1  FIG. 6 illustrates a variant of the instrument holder 30 comprising a hollow attachment portion 33 having a slit of shape and section corresponding to the hoop 1 so as to slide along it and a body 32 traversed by a housing open in which can be inserted and / or slide a trocar 150. The instrument holder 30 is held by friction in the desired position along the hoop 1
Le trocart est maintenu dans le porte instrument par des moyens connus de l'homme du métier, en particulier par mâchoire et/ou pincement.  The trocar is held in the instrument holder by means known to those skilled in the art, in particular by jaw and / or pinch.
Cette variante est notamment adaptée à un trocart de caméra correspondant. This variant is particularly suitable for a corresponding camera trocar.
La figure 7 illustre un autre exemple de porte-instrument 30 comportant une partie de fixation 34 munie de deux patins 33, ici sous forme de disques, pouvant coulisser le long de l'arceau 1 qu'il prend en sandwich. Le porte- instrument comporte un système de freins permettant à la partie de fixation 34 de rester en position par serrage le long de l'arceau 1 FIG. 7 illustrates another example of an instrument holder 30 comprising a fixing portion 34 provided with two pads 33, here in the form of discs, being able to slide along the arch 1 which he sandwiches. The instrument holder comprises a brake system allowing the fixing portion 34 to remain in position by clamping along the hoop 1
Le porte-instrument 30 comporte un corps 32 avec un logement apte à recevoir un trocart pour le passage d'un instrument chirurgical.  The instrument holder 30 comprises a body 32 with a housing adapted to receive a trocar for the passage of a surgical instrument.
Optionnellement, le corps 32 du porte-instrument 30 peut être réglable en translation et en rotation par rapport à un axe W distinct de l'axe Z, en particulier perpendiculaire à l'axe Z.  Optionally, the body 32 of the instrument holder 30 can be adjustable in translation and in rotation relative to an axis W distinct from the Z axis, in particular perpendicular to the Z axis.
On a illustré figure 8 le positionnement d'un membre M à opérer sur le support 62 d'un dispositif selon l'invention.  FIG. 8 illustrates the positioning of a member M to operate on the support 62 of a device according to the invention.
Le dispositif 100 est similaire à celui des figures 1 et 2. Il comporte un châssis 50 ayant la forme d'un carré de 40 cm de côté. L'invention n'est pas limitée à une forme de châssis particulière. Celui-ci peut être rectangulaire de dimensions par exemple comprises entre 30 cm et 100 cm. Les arceaux sont des arcs de cercle dont le rayon est compris entre 25cm et 50cm  The device 100 is similar to that of Figures 1 and 2. It comprises a frame 50 having the shape of a 40 cm square. The invention is not limited to a particular form of chassis. This may be rectangular of dimensions for example between 30 cm and 100 cm. The arches are arcs whose radius is between 25cm and 50cm
Le dispositif pré-positionné repose sur la table d'opération par l'intermédiaire des deux pieds 5 allongés et parallèles. Dans l'exemple illustré, le dispositif chirurgical 100 comporte optionnellement une tablette 60 munie d'un support 62 destinée à recevoir le membre à opérer, par exemple une main. Le support 62 et la tablette 60 forment ici une pièce unique, étant par exemple réalisés conjointement par moulage ou par assemblage.  The pre-positioned device rests on the operating table via the two elongated and parallel legs. In the illustrated example, the surgical device 100 optionally includes a tablet 60 provided with a support 62 for receiving the member to operate, for example a hand. The support 62 and the shelf 60 form here a single piece, being for example made jointly by molding or assembly.
Après avoir marqué à l'aide d'un marqueur radio opaque un ou plusieurs points f sur le membre M, par exemple trois points comme illustré, on obtient par imagerie médicale au moins une image du membre et de la zone à opérer.  After having marked with an opaque radio marker one or more points f on the member M, for example three points as illustrated, one obtains by medical imaging at least one image of the limb and the area to be operated.
Le système d'imagerie calcule par exemple le positionnement du membre M, des arceaux, et des instruments.  The imaging system calculates for example the positioning of the member M, arches, and instruments.
Le chirurgien positionne le membre M sur le support 62 selon les indications données par le système d'imagerie. Il vérifie la position à l'aide du pointeur laser 300 comme illustré. Le système vérifie et éventuellement corrige la position de chaque arceaux 1 et de chaque porte-instrument 30 afin d'orienter les instruments vers le point à traiter situé sous la peau, au niveau de l' intersection des axes Z.  The surgeon positions the member M on the support 62 according to the indications given by the imaging system. It checks the position with the laser pointer 300 as illustrated. The system checks and possibly corrects the position of each arches 1 and each instrument holder 30 in order to orient the instruments towards the point to be treated located under the skin, at the intersection of the Z axes.
Le système motorisé règle également la position des trocarts dans les porte- instruments. Chaque élément du dispositif 100, arceau, châssis, peut être réalisé en métal notamment titane, inox, aluminium, ou dans une matière plastique rigide. The motorized system also regulates the position of the trocars in the instrument holders. Each element of the device 100, hoop, chassis, can be made of metal including titanium, stainless steel, aluminum, or a rigid plastic material.
Le dispositif peut être stérilisé, notamment plusieurs fois.  The device can be sterilized, in particular several times.
Le dispositif 100 représenté partiellement figure 9 comporte un unique arceau 1 ayant une forme circulaire d'anneau complet. L'arceau 1 est fixé à un moyeu 2, mobile en rotation autour de l'axe R.  The device 100 partially represented in FIG. 9 comprises a single hoop 1 having a complete circular ring shape. The hoop 1 is fixed to a hub 2, mobile in rotation about the axis R.
L'arceau 1 peut tourner de 360° sur lui-même autour de l'axe de rotation R, même lorsqu'il porte deux porte-instruments 30 comme illustré.  The hoop 1 can rotate 360 ° about itself around the axis of rotation R, even when it carries two instrument holders 30 as illustrated.
Les arceaux des dispositifs chirurgicaux illustrés ci-dessus présentent une section de forme aplatie, notamment rectangulaire comme illustrée en coupe à la figure 10A. Dans des variantes de réalisations un arceau peut présenter une section de forme différente, carrée comme illustrée figure 10B.  The arches of the surgical devices illustrated above have a section of flattened shape, including rectangular as shown in section in Figure 10A. In alternative embodiments a hoop may have a section of different shape, square as shown in Figure 10B.
Un arceau 1 peut être composé de plusieurs tubes, par exemple deux tubes circulaires de section identique comme illustré aux figures 10C et 10D ou différentes comme sur la figure 10E, formant une structure géométrique s'apparentant à des rails. Les tubes sont par exemple adjacents comme à la figure 10C ou non.  A hoop 1 may be composed of several tubes, for example two circular tubes of identical section as shown in Figures 10C and 10D or different as in Figure 10E, forming a geometric structure similar to rails. The tubes are for example adjacent as in Figure 10C or not.
Les arceaux illustrés sont pleins, on ne sort pas de l'invention avec des arceaux creux. Lors de l'intervention, aussi bien les porte-instruments portant la caméra que ceux portant les instruments chirurgicaux et les arceaux correspondant peuvent être manipulés par l'intermédiaire d'un système d'actionnement motorisé.  The arches illustrated are full, we do not leave the invention with hollow arches. During the procedure, both the instrument holders carrying the camera and those carrying the surgical instruments and the corresponding arches can be manipulated via a motorized actuation system.
Dans l'exemple de la figure 11, les pieds 5 du dispositif 100 sont solidaires, par l'intermédiaire de moyens de réglage 110, de quatre colonnes 120, positionnées aux quatre coins du dispositif 100, dans le prolongement des pieds 5. Les moyens de réglage 110 supportent les pieds 5 d'une part et sont reliés aux colonnes 120 d'autre part, de manière à permettre un déplacement vertical du dispositif 100, et donc un réglage en hauteur, à Γ aide de moteurs asservis 111. Les colonnes 120 présentent des crans 121 qui permettent un réglage identique aux quatre coins du dispositif 100. En partie inférieure, les colonnes 120 comportent une base élargie 125 pour assurer la stabilité de l'ensemble. La présence des colonnes 120 permet d'ajouter encore un axe de déplacement du dispositif 100. Dans une variante non illustrée, les moyens de réglage comportent des molettes de réglage.  In the example of FIG. 11, the feet 5 of the device 100 are secured, by means of adjustment means 110, of four columns 120, positioned at the four corners of the device 100, in the extension of the feet 5. The means Adjustment 110 supports the feet 5 on the one hand and are connected to the columns 120 on the other hand, so as to allow a vertical movement of the device 100, and therefore a height adjustment, with the aid of slave motors 111. The columns 120 have notches 121 which allow identical adjustment to the four corners of the device 100. In the lower part, the columns 120 comprise an enlarged base 125 to ensure the stability of the assembly. The presence of the columns 120 makes it possible to add another axis of movement of the device 100. In a variant that is not illustrated, the adjustment means comprise adjustment wheels.
L'invention n'est pas limitée aux exemples illustrés. Par exemple, le nombre d'arceaux peut être différent ainsi que le nombre de porte-instruments sur chaque arceau. Les arceaux peuvent être autres que des demi-cercles et présenter entre leurs extrémités un écart angulaire supérieur à 180°. The invention is not limited to the illustrated examples. For example, the number of arches may be different and the number of instrument holders on each arch. The arches may be other than semicircles and have between their ends an angular difference greater than 180 °.
Tous les degrés de liberté peuvent être verrouillés par un système de freins. L'expression « comportant un » est synonyme de « comportant au moins un ».  All degrees of freedom can be locked by a brake system. The phrase "having one" is synonymous with "having at least one".

Claims

REVENDICATIONS
1. Dispositif chirurgical (100) comportant au moins un arceau (1) mobile en rotation autour d'un axe (R) et réglable en position autour de cet axe et au moins un porte- instrument (30) mobile le long dudit au moins un arceau (1) et réglable en position sur celui-ci. 1. Surgical device (100) comprising at least one hoop (1) movable in rotation about an axis (R) and adjustable in position about this axis and at least one carrier (30) movable along said at least one a hoop (1) and adjustable in position thereon.
2. Dispositif selon la revendication 1, comportant un arceau (1) unique ou un ensemble (10) d'au moins deux arceaux (1) reliés entre eux, notamment traversés par un pivot d'axe (R).  2. Device according to claim 1, comprising a single arch (1) or an assembly (10) of at least two arches (1) interconnected, in particular through a pivot axis (R).
3. Dispositif selon la revendication 1 ou 2, chaque porte-instrument (30) comportant des moyens de positionnement de l'instrument axialement selon un axe propre (Z).  3. Device according to claim 1 or 2, each instrument holder (30) having means for positioning the instrument axially along a proper axis (Z).
4. Dispositif selon la revendication précédente, les axes (Z) de déplacement axial des porte-instruments se coupant en un point (O) fixe par rapport à le ou les arceaux et les axes (Z) pivotant autour du point (O) en fonction des déplacements des arceaux et des porte-instruments (30).  4. Device according to the preceding claim, the axes (Z) of axial displacement of the instrument carrier intersecting at a point (O) fixed relative to the or the arcs and axes (Z) pivoting about the point (O) in function of the movements of the arches and the instrument holders (30).
5. Dispositif selon l'une quelconque des revendications précédentes, au moins un des arceaux (1) ayant la forme d'un demi-cercle.  5. Device according to any one of the preceding claims, at least one of the arches (1) having the shape of a semicircle.
6. Dispositif selon l'une quelconque des revendications précédentes, comportant un châssis (50) solidaire de l'arceau ou des arceaux, celui-ci respectivement ceux-ci étant mobile par rapport audit châssis, en particulier en translation le long d'un axe (X).  6. Device according to any one of the preceding claims, comprising a frame (50) integral with the arch or hoops, the latter respectively being movable relative to said frame, in particular in translation along a axis (X).
7. Dispositif selon la revendication précédente, le châssis (50) comportant au moins un moyen de fixation (65) mobile selon un deuxième axe (Y), notamment perpendiculaire à l'axe (X), le moyen de fixation (65) étant configuré pour recevoir, de façon amovible ou non, une tablette (60) pour recevoir la partie à opérer d'un patient.  7. Device according to the preceding claim, the frame (50) comprising at least one fastening means (65) movable along a second axis (Y), in particular perpendicular to the axis (X), the fastening means (65) being configured to receive, removably or not, a tablet (60) for receiving the portion to be operated on a patient.
8. Dispositif selon l'une quelconque des revendications précédentes, comportant au moins un système d'actionnement motorisé (80), notamment pilotable par une liaison sans fil, agencé pour déplacer et maintenir en position au moins l'un des arceaux (1 ), l'un des porte-instruments (30), un moyen de fixation (15, 65), et/ou un trocart (150) ou un instrument (135) logé dans un porte-instrument (30). 8. Device according to any one of the preceding claims, comprising at least one motorized actuating system (80), in particular controllable by a wireless link, arranged to move and maintain in position at least one of the arches (1). , one of the instrument holders (30), a fixing means (15, 65), and / or a trocar (150) or an instrument (135) housed in an instrument holder (30).
9. Dispositif selon l'une quelconque des revendications 2 à 8, l'ensemble (10) comportant trois arceaux. 9. Device according to any one of claims 2 to 8, the assembly (10) comprising three arches.
10. Dispositif selon l'une quelconque des revendications précédentes, comportant un pointeur laser (300).  10. Device according to any one of the preceding claims, comprising a laser pointer (300).
11. Porte-instrument (30) pour un dispositif chirurgical (100) selon l'une quelconque des revendications précédentes comportant un système, notamment motorisé, pour déplacer et maintenir en position un trocart (150) ou un instrument (135) logé dans le porte-instrument (30) et/ou le porte-instrument (30) sur un arceau (1 ) du dispositif (100).  11. An instrument holder (30) for a surgical device (100) according to any one of the preceding claims including a system, particularly motorized, for moving and holding in position a trocar (150) or an instrument (135) housed in the instrument holder (30) and / or the instrument holder (30) on a bow (1) of the device (100).
12. Procédé de calcul de la position des instruments chirurgicaux, notamment lors d'une intervention laparoscopique, de diagnostic ou de chirurgie, à l'aide d'un dispositif chirurgical (100) selon la revendication 10, comportant la détermination du point de focalisation de la chirurgie par réalisation d'une image par imagerie médicale et le calcul, à partir de ce point, de la position de chaque composant du dispositif afin d'orienter les instruments vers le point à traiter.  12. Method for calculating the position of the surgical instruments, in particular during a laparoscopic, diagnostic or surgical intervention, with the aid of a surgical device (100) according to claim 10, comprising the determination of the point of focus surgery by performing an image by medical imaging and calculating, from this point, the position of each component of the device to guide the instruments to the point to be treated.
PCT/IB2015/052907 2014-04-22 2015-04-21 Exocentric surgical device WO2015162555A1 (en)

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